A Cross-Sectional Study on Patterns of Lymph Node Involvement And Metastasis in Tongue Cancer

Abstract

Background: Cancer of the tongue mucosa may present as an indurated ulcer with raised edges or as an exophytic growth. Approximately one third of the patients come in to the hospital with a neck swelling. Lymph nodes are an important part of immune system and play a crucial role in tumorprogression. The present study is an attempt to diagnose lymph node involvement and the pattern of metastasis among different groups of lymph node with the tongue cancer and helps to create accurate clinical staging and appropriate choice of neck dissection, thus reduce tumor recurrence and cancer-specific mortality.  

Materials and methods: This cross-sectional observational study was conducted in Sir Salimullah Medical College, Dhaka from March 2019 to February 2020 for a period of one year. A total no of fifty patients suffering from tongue cancer admitted in the Department of Otolaryngology during study period were included. Imaging of neck was done for diagnosis and staging of lymph node. Data were collected and analyzed by using Statistical Package for social Science version 25.

Results: A total of 50 patients with tongue carcinoma were included in this study. The mean age of the patients was 55.08 ± 11.97 years (Range: 35–75 years) with the majority of patients aged 51–60 years (38%) followed by those above 60 years (28%). Among all patients, 66% had cervical lymph node metastasis, while 34% had no metastatic lymph node involvement. Among metastatic cases (n=33), Level II lymph node involvement was the most common (51.5%), followed by combined Level I+II involvement (30.3%) isolated Level I involvement (15.1%) and Level I+II+III involvement (3.0%). Single lymph node metastasis was more common in oral tongue carcinoma (78.6%) whereas multiple nodal metastases were more frequent in base of tongue carcinoma (57.9%). Regarding tumor size, 50% of oral tongue tumors were <3 cm, while most base of tongue tumors (63.2%) measured 3–6 cm.For tumor staging, T2 stage was the most common stage in both oral tongue (64.3%) and base of tongue carcinoma (36.8%). In nodal staging, N2 stage was predominant in oral tongue (57.1%) and base of tongue cancers (47.4%). A statistically significant association was found between tumor stage and nodal stage in both oral tongue (p=0.003) and base of tongue carcinoma (p=0.006).

Conclusions: Tongue cancers usually cause symptoms related to the upper aero digestive tract, including difficulty in swallowing, speech and breathing.  

JCMCTA 2026 ; 37 (1) : 91-96